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"Best" health care in the world? You judge...

Posted by John McDonough  July 24, 2013 12:10 PM

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The two most influential Americans trying to block implementation of the Affordable Care Act have a clear reason for doing so. U.S. House Speaker John Boehner calls our health care system "the best health care delivery system in the world." U.S. Senate Minority Leader Mitch McConnell says we have "the finest health care system in the world." Who would want to mess with that?

Who indeed?

Take a look at the chart below which was published in the July 10 2013 issue of the Journal of the American Medical Association in an important and under-reported article, "The State of US Health, 1990-2010 Burden of Diseases, Injuries, and Risk Factors" (available free).

GBD World Ranks.jpg


Shorthand: green indicates better performance, yellow average performance, and red worse performance.  The U.S. has the highest number of reds and the lowest number of greens of any nation in this selection of nations belonging to the Organization for Economic Cooperation and Development (OECD). 

The good news is that, between 1990-2010 (from 75.2 to 78.2 between 1990-2010), the U.S. has seen improved outcomes on life expectancy and other important health indicators. The bad news is, our rate of improvement is among the worst of all leading industrialized nations, and dropped from 18th to 27th in age standardized death rate between 1990-2010. Here is the article's conclusion:

"From 1990 to 2010, the United States made substantial progress in improving health. Life expectancy at birth and HALE increased, all-cause death rates at all ages decreased, and age-specific rates of years lived with disability remained stable. However, morbidity and chronic disability now account for nearly half of the US health burden, and improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations.

"The United States spends the most per capita on health care across all countries, lacks universal health coverage, and lags behind other high-income countries for life expectancy and many other health outcome measures. High costs with mediocre population health outcomes at the national level are compounded by marked disparities across communities, socioeconomic groups, and race and ethnicity groups. Although overall life expectancy has slowly risen, the increase has been slower than for many other high-income countries. In addition, in some US counties, life expectancy has decreased in the past 2 decades, particularly for women.

"Decades of health policy and legislative initiatives have been directed at these challenges; a recent example is the Patient Protection and Affordable Care Act, which is intended to address issues of access, efficiency, and quality of care and to bring greater emphasis to population health outcomes. There have also been calls for initiatives to address determinants of poor health outside the health sector including enhanced tobacco control initiatives, the food supply, physical environment, and socioeconomic inequalities."


Much to learn from this study which is part of a growing literature on the "global burden of disease" undertaken by a significant number of health researchers from all over the world.

Because the U.S. spends as much as 50% more per person on health care than the average of our leading peer nations, we might expect to do better or at least as well as our international peers. Not so.

"Finest" and "best" health care system in the world? Not even close.

(Tip of the hat to the always excellent blog, The Incidental Economist, for their commentary on the report.)

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »

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